The health care debate appears headed toward presenting states with two very different possible paths—and both have big drawbacks.

Many state leaders are hoping for a bipartisan deal to shore up the current health care system, but lawmakers last week delivered language for two extreme options: One that would provide states more power but less money and another that would shift authority and financial responsibility to the federal government.

“The focus is clearly front-and-center on stabilization. It’s hard enough getting that done and that’s where priorities are,” said Trish Riley, executive director for the National Academy for State Health Policy.

Senate Health committee chair Lamar Alexander said he wants an Affordable Care Act stabilization agreement—possibly including cost-sharing payments, more-flexible state waivers, and allowing more people to buy catastrophic plans—early this week.

Separately, Sens. Bill Cassidy and Lindsey Graham are proposing to give states more power over health care in a last-ditch effort to save their goal to repeal and replace Obamacare. At the other end of the spectrum, many Democrats are rallying around Sen. Bernie Sanders’s push to create a single-payer health care system.

The Graham-Cassidy plan would replace the current tax credits, cost-sharing-reduction subsidies, the Basic Health Program, and Medicaid expansion money with a federal block grant. It would give states leeway over how the money is used and provides state waivers to allow insurers to vary premiums based on factors such as health status. States could also waive the essential health benefits required under the Affordable Care Act.

That plan could face the same opposition from governors and stakeholders as some of the other Republican attempts to overhaul Obamacare, particularly because of the proposed slowed spending for Medicaid.

“Obviously Cassidy-Graham is going to be a saver,” said Chris Sloan, senior manager at Avalere Health. “There’s going to be less federal funding going to the states for health care.”

The liberal-leaning Center on Budget and Policy Priorities estimates that the block grant would provide $239 billion less between 2020 and 2026 than currently projected for Medicaid expansion and marketplace-subsidies spending. The proposed per capita cap on Medicaid would cut funding for the program by $39 billion in 2026. “In general, over time, the plan would punish states that have adopted the Medicaid expansion or been more successful at enrolling low- and moderate-income people in marketplace coverage under the ACA,” the center said.

Republican supporters tout the measure as an equalizer between states that expanded Medicaid and those that did not. “When it comes to different states, obviously non-expansion states like Wisconsin are going to finally get some equity in terms of the distribution of Obamacare dollars,” said Sen. Ron Johnson.

But this would likely put Democratic states at a disadvantage. “States come out very differently under Graham-Cassidy,” said health care expert Timothy Jost, a professor at Washington and Lee University School of Law. “Generally, Democratic states do much worse and Republican states do much better.”

Graham boasted last week that they already had about 14 or 15 governors “in the bank.” Utah Gov. Gary Herbert is backing the Republican plan, according to the Associated Press. But Ohio Gov. John Kasich tweeted over the weekend that a sustainable solution to health care requires a bipartisan solution.

States would have a lot less flexibility under the Sanders proposal—the Medicare for All Act— although the plan does allow states to set additional standards when it comes to eligibility, benefits, and minimum provider standards. The plan would largely replace existing federal health programs—including Medicaid, traditional Medicare, and the Children’s Health Insurance Program—and end the Affordable Care Act exchanges.

While the states would not have as much control of health care benefits at the local level, experts say this could help states simplify their budgets.

Cost is a constant concern around single-payer proposals. Some states have attempted to implement their own single-payer proposals, but financing sidelined the ideas. The dynamic would be different if Washington was in charge.

“I think on the financing question, the federal government is in the better position to finance health care,” said Matthew Fiedler, former chief economist for the Obama administration’s Council of Economic Advisers. “There are questions about program design on the state level or federal level … but I think the financing question is fairly clear cut.”

Movement on a single-payer idea is a long way off, and Republican leadership is uncertain whether the Cassidy-Graham proposal has a real chance to pass. For now, Alexander is hoping that lawmakers can meet somewhere in the middle on a smaller measure.

“To get a result, Republicans will have to agree to something, additional funding through the Affordable Care Act, that some are reluctant to support,” Alexander said in prepared remarks. “And Democrats will have to agree to something, more flexibility for states, that some are maybe reluctant to support.”

"President Trump signed a sweeping spending bill Friday afternoon, averting another partial government shutdown. The action came after Trump had declared a national emergency in a move designed to circumvent Congress and build additional barriers at the southern border, where he said the United States faces 'an invasion of our country.'"

Source:

REDIRECTS $8 BILLION

Trump Declares National Emergency

6 days ago

THE DETAILS

"President Donald Trump on Friday declared a state of emergency on the southern border and immediately direct $8 billion to construct or repair as many as 234 miles of a border barrier. The move — which is sure to invite vigorous legal challenges from activists and government officials — comes after Trump failed to get the $5.7 billion he was seeking from lawmakers. Instead, Trump agreed to sign a deal that included just $1.375 for border security."

Source:

COULD SOW DIVISION AMONG REPUBLICANS

House Will Condemn Emergency Declaration

6 days ago

THE DETAILS

"House Democrats are gearing up to pass a joint resolution disapproving of President Trump’s emergency declaration to build his U.S.-Mexico border wall, a move that will force Senate Republicans to vote on a contentious issue that divides their party. House Judiciary Committee Chairman Jerrold Nadler (D-N.Y.) said Thursday evening in an interview with The Washington Post that the House would take up the resolution in the coming days or weeks. The measure is expected to easily clear the Democratic-led House, and because it would be privileged, Senate Majority Leader Mitch McConnell (R-Ky.) would be forced to put the resolution to a vote that he could lose."

Source:

MILITARY CONSTRUCTION, DRUG FORFEITURE FUND

Where Will the Emergency Money Come From?

1 weeks ago

THE DETAILS

"ABC News has learned the president plans to announce on Friday his intention to spend about $8 billion on the border wall with a mix of spending from Congressional appropriations approved Thursday night, executive action and an emergency declaration. A senior White House official familiar with the plan told ABC News that $1.375 billion would come from the spending bill Congress passed Thursday; $600 million would come from the Treasury Department's drug forfeiture fund; $2.5 billion would come from the Pentagon's drug interdiction program; and through an emergency declaration: $3.5 billion from the Pentagon's military construction budget."

Source:

TRUMP SAYS HE WILL SIGN

House Passes Funding Deal

1 weeks ago

THE DETAILS

"The House passed a massive border and budget bill that would avert a shutdown and keep the government funded through the end of September. The Senate passed the measure earlier Thursday. The bill provides $1.375 billion for fences, far short of the $5.7 billion President Trump had demanded to fund steel walls. But the president says he will sign the legislation, and instead seek to fund his border wall by declaring a national emergency."